Honoring the Health Sacrifices of Our Veterans

“On Veterans Day, America pauses to honor every service member who has ever worn one of our Nation’s uniforms. Each time our country has come under attack, they have risen in her defense. Each time our freedoms have come under assault, they have responded with resolve. Through the generations, their courage and sacrifice have allowed our Republic to flourish. And today, a Nation acknowledges its profound debt of gratitude to the patriots who have kept it whole.

As we pay tribute to our veterans, we are mindful that no ceremony or parade can fully repay that debt. We remember that our obligations endure long after the battle ends, and we make it our mission to give them the respect and care they have earned. “

These two paragraphs are taken directly from the 2013 Veterans Day Presidential Proclamation.

But getting Veterans the care they deserve is not always easy.  The wounds of war can go far beyond what meets the eye. From mental health issues to pain and illness that persist long after they’ve left the battlefield, veterans face a multitude of health troubles either unique to their service or more frequent among them than the general population.

“Folks returning from combat have a constellation of health concerns, including physical issues, psychological issues and psychosocial issues concerning things like work and family,” said Dr. Stephen Hunt, national director of the U.S. Department of Veterans Affairs Post Deployment Integrative Care Initiative.

Some of the most common physical complaints of returning soldiers cannot be classified into a single disorder. They include nonspecific symptoms such as fatigue, pain and cognitive disturbances such as memory and concentration problems.

Here are seven of the most commonly seen health conditions confronting veterans:

Musculoskeletal injuries and pain

Just over half of all veterans’ post-deployment health visits address lingering pain in their backs, necks, knees or shoulders.  According to a study in the Journal of Pain, about 100,000 veterans of the Gulf War nearly 20 years ago have reported chronic muscle pain.

Mental health issues

While post-traumatic stress disorder (PTSD) among soldiers has been well publicized, other mental woes can also result from the trauma of war. A study in the journal Archives of General Psychiatry [now JAMA Psychiatry] found that one in 10 Iraq war vets develop serious mental problems, including violent behavior, depression and alcohol abuse. The study found that PTSD or depression seriously impaired daily functioning in 8.5 – 14% of these vets.  Disabling on its own, PTSD is also linked to the development of physical illnesses for veterans as years pass. Researchers from Walter Reed Army Medical Center reported that 54% of veterans with PTSD also had sleep apnea, compared with 20%of PTSD patients in the general population. PTSD in vets is also associated with a greater risk of developing dementia.

Chemical exposure

Research by the American Heart Association found that exposure to nerve agents such as sarin – which can trigger convulsions and death on the battlefield – may cause long-term heart damage in Gulf War veterans. The damage can include an enlarged left ventricle, heart rhythm abnormalities or a reduction in the pumping strength of the heart.

Infectious diseases

Although all military personnel are given routine vaccinations before deployment, veterans suffer disproportionately from certain infections that civilians almost never experience.  They include bacterial infections such as brucellosis, which may persist for years; campylobacter jejuni, which causes abdominal pain, fever and diarrhea; and Coxiella burnetii, which in chronic cases can inflame the heart.

Leishmaniasis, a parasitic disease caused by the bite of a sand fly native to the Middle East, is a particularly brutal condition veterans experience. Those infected suffer weight loss, fevers, headaches, muscle pain and weakness, anemia, and enlargement of the spleen and liver. It can be fatal if untreated, according to the VA..

Traumatic Brain Injury (TBI)

TBI, often brought on by a blow or jolt to the head, disrupts brain function and has been called the signature wound of the fighting in Iraq and Afghanistan, according to the National Academy of Sciences. Blast exposures and other combat-related activities put service members at greater risk for sustaining a TBI compared to their civilian counterparts, according to the Defense and Veterans Brain Injury Center.

Common effects of TBIs include cognitive issues such as shorter attention span, language disabilities, and an inability to process information. Vets can also suffer from lack of motivation, irritability, anxiety and depression, headaches, memory loss and PTSD.

However, you choose to mark Veteran’s Day 2013, please remember the sacrifices made by all of our vets and be mindful of the long-term health problems they face. Ladies and Gentleman of the military, we thank you for your service.

Pediatricians Propose Policy to help Hollaback Girls

It’s official!  Cheerleading – love it or hate it –  isn’t just about short skirts, big smiles and pompom waving.  According to a new policy statement from the American Academy of Pediatrics (AAP), cheerleading is just as athletic and potentially as dangerous as a sport and should be designated as one.

In addition, to making it a sport, the AAP urges coaches, parents and school officials to follow injury-prevention guidelines, develop emergency plans and ensure cheerleading programs have access to the same level of qualified coaches, medical care and injury surveillance as other sports. They also recommend better supervision including on-site athletic trainers, limits on practice time and better qualified coaches.

“Not everyone is fully aware of how cheerleading has evolved over the last couple of decades. It used to be just standing on the sidelines and doing cheers and maybe a few jumps,” said Cynthia LaBella MD, a sports medicine specialist at Chicago’s Lurie Children’s Hospital.

Injuries have increased as cheerleading has become more popular.  Over the last two decades, the number of cheerleaders injured has climbed dramatically. Hardly surprising given that cheerleaders engage in stunts such as creating human pyramids that reach 15 feet high or more.  Common injuries include severe sprains, broken arms and legs, neck injuries and concussions.

Last year alone, there were almost 37,000 documented emergency room visits for cheerleading injuries among girls aged 6 to 22.  That’s a 400% increase from the 1980.  And while the overall injury rate in high school cheerleading is lower than in other girls sports, such as gymnastics, soccer and field hockey, the rate of catastrophic injuries like skull fractures and spinal paralysis is higher.  In fact, cheerleading accounts for 66% of all catastrophic injuries in high school female athletes.

Data suggest there are more than 3 million cheerleaders nationwide, most of them girls.  While most belong to traditional cheerleading squads that support schools’ athletic teams, many schools have also created competitive cheering teams.
Some schools and state high school sports associations already consider cheerleading a sport and require the kind of safety oversight that the academy is recommending. But many do not, says Jim Lord, executive director of the American Association of Cheerleading Coaches & Administrators.

Lord and the AAP agree on a number of safety recommendations including limiting the height of human pyramids in high school cheerleading to just two people and banning routines that include pyramids, tumbling or tosses from being performed on hard surfaces.

Lisa Kluchorosky, a sports medicine specialist who works with the academy and the National Athletic Trainers Association, believes the new policy will not only help to reduce injuries but also help erase misconceptions that cheerleading is not very athletic.

What do you think?

Diabetes Drug may Repair Injured Brains

Here’s a good brain teaser for a Wednesday.  What do an old diabetes drug, brain injury and Alzheimer’s Disease have in common?

Here’s some clues to help you solve the riddle.

(i)           Metformin is a widely used treatment for type II diabetes

(ii)          An increasing proportion of people with Alzheimer’s Disease also have diabetes

(iii)         Hyperinsulinemia (excess levels of insulin in the blood) may enhance the onset and progression of neurodegeneration

Have you solved it?  If so, congratulations!

If not, the answer, according to data just published in the journal Cell Stem Cell is that the former may hold the clue to treating the latter.

In other words, the study suggests that metformin, an anti-diabetes drug first discovered in the 1920’s, is able to help activate the mechanism that signals stem cells to generate brain cells.

Principal investigator, Freda Miller, a Professor from the Department of Molecular Genetics at the University of Toronto
says “If you could take stem cells that normally reside in our brains and somehow use drugs to recruit them into becoming appropriate neural cell types, then you may be able to promote repair and recovery in at least some of the many brain disorders and injuries for which we currently have no treatment.”

The research involved laboratory experiments using both mouse and human brain stem cells, as well as learning and memory tests performed on live mice given the drug.

Miller and her colleagues started by adding metformin to stem cells from the brains of mice, then repeated the experiment with human brain stem cells generated in the lab. In both cases, the stem cells gave rise to new brain cells.

They then tested the drug in lab mice and found that those given daily doses of metformin for two or three weeks had increased brain cell growth and outperformed rodents not given the drug in learning and memory tasks.

In the key experiment, mice were forced to learn the position of a platform hidden under the surface of a water-filled maze and then asked rapidly to learn a new position.

Mice were injected with either metformin or saline for 38 days. On days 22 through 38, they learned the initial position of the platform, which provided an escape from the water-filled maze.  Then the platform was moved to the opposite side of the maze, and the animals were asked again to learn its position. In both tasks, the mice learned the platform positions with equivalent speed.

But when they were put back in the maze – this time with the platform removed – control mice spent more time searching for it in the original position, while the metformin-treated animals preferentially looked in the new region.

The implication  is that metformin helped the mice form their new memories of the second platform position. Further analysis showed that their enhanced ability was paralleled by an increase in the number of  neurons.

In a separate study researchers have shown that metformin can increase lifespan and delay the onset of cognitive impairment in a mouse model of Huntington’s disease.

Taken together, these findings raise the possibility that metformin’s ability to enhance neurogenesis might have a positive impact in some nervous system disorders.

Miller’s team is already planning a pilot study to test metformin in young patients with acquired brain damage, either as result of treating a childhood brain tumor or from a traumatic head injury.

We will report back to you with results, as they are published.

Sexy Treatment for Traumatic Brain Injury?

Traumatic Brain Injury (TBI) is a serious public health problem that affects more than 1.7 million Americans each year.  It is the leading cause of death and disability in children and young adults worldwide and is responsible for more than 52,000 deaths, 275,000 hospitalizations, and 80,000 cases of long-term disability in the US alone.

Caused by a bump, blow or jolt to the head or a penetrating head injury, a TBI disrupts the normal function of the brain. The severity of a TBI may range from “mild” – a brief change in mental status or consciousness to “severe” – an extended period of unconsciousness or amnesia after the injury.  Contrary to most media portrayals, the leading cause of TBI is not injuries sustained during war or football, but road traffic accidents.

Despite significant efforts over the past 20 years, there is still no approved treatment to reverse the damage caused by TBI. However, there is a growing body of research to suggest that the sex hormone progesterone may be a powerful neurosteroid that can protect against the effects of TBI.

Discovery of progesterone’s neuroprotective properties began with the observation of a gender difference in response to experimentally induced traumatic brain injury (TBI). After noting anecdotal reports that female rats recover better than male rats following TBI, researchers conducted studies which showed that the hormone might account for this discrepancy in outcomes.

And while progesterone initially may seem like an unusual choice as a neuroprotective therapeutic agent, there is abundant evidence suggesting that this is a normal role of this steroid hormone. In addition to its well-known effects on the reproductive system, progesterone is a potent neurosteroid.  Progesterone receptors are abundant and widely distributed in the central nervous system. Moreover, unlike other sex steroids, progesterone is not only synthesized in the gonads and adrenal glands, but also produced by glial cells in the brain and by Schwann cells in the peripheral nervous system.

BHR Pharma, based in Herndon VA, has developed BHR-100, a novel intravenous formulation of progesterone for treating TBI.   The company’s Phase III multi-center SyNAPSe clinical trial is currently underway and has enrolled 500 of the 1,180 patients suffering from severe TBI needed.

BHR Pharma, is also studying BHR-310 (intranasal progesterone powder) a ready-for-use, nasal spray TBI treatment.  The compound is being developed so that it may be administered to wounded warriors at the site of injury, without the help of medically trained personnel. Studies of progesterone for TBI show that the earlier progesterone is given the better the chance to prevent further damage and improve recovery. A simple nasal spray device would therefore allow the progesterone to begin working before patients are admitted to a hospital.

The FDA has granted Orphan Drug designation to BHR-100 and the drug is on a Fast Track status designed to accelerate its potential approval.  SRxA’s Word on Health will continue to follow these developments and bring you news as it breaks.

Honoring Our Military

Today, Veterans Day, our nation honors the men and women who have served our country. Cities host parades, department stores have sales, schools and the Federal Government close. Most of us are thankful for a day off. But how many of us will stop and think about the tremendous sacrifices made by those in the military community – the risks they take and the burdens they carry? And how many of us will take the time to reflect on how families and lives are forever changed as a result of war?

Since September 11, 2001, over 2 million men and women have deployed to fight the wars in Iraq and Afghanistan – many of these have deployed multiple times.  During this time, countless family members have suffered through multiple separations. And let’s not forget the 5,798 American men and women who have died during these wars or the 40,000 who have come home with significant physical injuries. In addition, many of our troops come home with invisible injuries of war including post traumatic stress, traumatic brain injury, depression and anxiety.

Sadly, a large number of those who suffer these invisible injuries fail to seek the care that they so need and deserve. The stigma associated with seeking mental health care and our cultural reluctance to admit mental health concerns prevents many of the brave men and women in our armed forces from obtaining proper treatment.

Families are suffering. A recent study in the journal, Pediatrics, found that young children in military families are about 10% more likely to see a doctor for a mental health difficulty when a parent is deployed than when the parent is home. Social scientists have long known that the cycle of deployment and reintegration puts a significant strain on the families of those who serve, particularly spouses. Given that the conflict in Iraq has been underway for over seven long years, tens of thousands of military children have only known the experience of war.

While most civilians are familiar with the terms “post traumatic stress” and “traumatic brain injury” it is striking how little the average person knows about these very understandable, yet potentially devastating, consequences of war.  Movies and television programs often portray veterans suffering with post traumatic stress as out-of-control and hyper-aggressive. While difficulties with impulse control and rage are indeed possible manifestations there is a range of other symptoms and reactions that are less well known. Some withdraw and become disengaged from those around.  Others have difficulty finding meaning in life, while others may experience anxiety, flashbacks and severe sleep disturbance. Sometimes the painful mental health symptoms that result from the experience of war lead to self-medication and substance abuse and suicide. Then there is the dramatic increase in the number of suicides reported by active duty personnel as well as those who have separated from the military.

Some members of our military community come home to families that cannot possibly understand what they have seen or done. Unable to bridge the gap between who they were when they deployed and who they are upon return, our service members find themselves in relationships that falter and marriages that fail.

But there is reason to hope. Many within government and Veterans Affairs, the academic community, the nonprofit sector, the entertainment industry, and caring individuals in communities across the country are stepping up to assist those who serve our country and their families.

The rest of us can help by recognizing and accepting psychological injuries of war and encouraging our veterans to receive proper care and treatment in a timely manner.  Together, we can stem the tide of suicides and save hundreds of thousands of service members who have come home from war with injuries that they alone cannot heal. In order to be successful in this mission, however, we must harness the goodwill, the knowledge, the resources and the commitment of a thankful nation that recognizes the sacrifices made by so few for so many.

SRxA’s Word on Health would like to honor and thank all of our Veterans.

Multitasking as a Diagnostic Tool?

Here at Word on Health we’re used to doing a million things at once. So over the years, we’ve  heard most of the multitasking jokes. Admittedly we’ve chuckled at the male definition known as chewing gum and breaking wind at the same time.  We’ve even been known to smile when men ask, “if women are so good at multitasking why can’t they have sex and a headache at the same time?”

However, it turns out that it’s no laughing matter.

Scientists hope to use a simple multitasking challenge – walking and thinking at the same time –  to quickly screen individuals who may have suffered brain injuries. According to researchers at the Georgia Tech Research Institute (GTRI) asking an individual to walk a short distance while saying the months of the year in reverse order, can determine if that person is impaired and possibly suffering from a concussion.

This simple test involving radar, which could be performed on the sideline of a sporting event or on a battlefield, has the potential to help coaches and commanders decide if athletes and soldiers are ready to engage in activity again.

“When a person with a concussion performs cognitive and motor skill tasks simultaneously, they have a different gait pattern than a healthy individual, and we can identify those anomalies in a person’s walk with radar,” said GTRI research engineer Jennifer Palmer.

More than 1 million concussions and other mild traumatic brain injuries are reported each year in the United States.  Catching them right after they happen can improve treatment and prevent further injury or other long-term health issues. Diagnosing concussion can be difficult, though, because the symptoms are not always easily visible or detectable, even though they last for weeks or months following the incident.

While methods exist for detecting concussion, most focus purely on cognitive impairment and do not assess accompanying motor skill deterioration.

Details of GTRI’s technique, which simultaneously examines a person’s cognitive and motor skills, were presented on April 26 at the SPIE Defense, Security and Sensing conference in Orlando. Using radar for gait analysis would be faster and less intrusive than existing techniques. The assessment would be done with radar systems similar to those used by police for measuring the speed of vehicles.

The GTRI research team compared how 10 healthy individuals walked normally and when impaired. For the impairment scenario, individuals wore goggles that simulated alcohol impairment. Past research has shown that concussion impairment is equivalent to having a blood alcohol level of 0.05%.

Each individual performed four 30-second walking tasks: a normal walk, walk while saying the months of the year in reverse order, walk while wearing the goggles, and walk while wearing the goggles and performing the cognitive task. For each task, the subjects walked away from the radar system, turned around and walked back toward the radar system.

By looking for differences in the gait patterns of normal and impaired individuals, researchers found that healthy individuals could be distinguished from impaired individuals wearing the goggles. Healthy individuals demonstrated a more periodic gait with regular and higher velocity foot kicks and faster torso and head movement than impaired individuals when completing a cognitive task.

The results also indicated that if no cognitive task was performed, a healthy individual’s gait pattern was not statistically different when wearing and not wearing the goggles.

“We found that we needed to examine a person’s physical and mental capabilities at the same time to see a change in gait and detect impairment,” said research engineer Kristin Bing. “It’s easy for a person to concentrate on one task, but when that person has to multitask we can begin to discriminate between someone who is impaired and someone who is not.”

In the future, the researchers plan to reduce the size of the system so that it becomes more practical to use.

Although approval from the Food and Drug Administration will be required before this system can be used to diagnose concussion, seems this multitasking tool is no joke.